Treatment of pressure ulcers in patients with spinal cord injury: Conventional surgery vs. cellular therapy.

CONTEXT: Relapse and recurrence rates of pressure injuries (PIs) are very high in spinal cord injured patients. That is the reason why alternative therapies, such the stem cells derived from bone marrow, have been developed. OBJECTIVE: To compare this new technique of infiltration-infusion of mononuclear cells from bone marrow with conventional surgery. DESIGN: A retrospective study was carried out in patients with spinal cord injuries who had PIs, category III/IV, in the pelvic area, during a 14-year follow-up period. SETTING: One group was treated with conventional surgery and, in the other group, mononuclear cells were infused. PARTICIPANTS: One hundred and forty-nine patients were registered, 63 (42.3%) in the conventional surgery group and 86 (57.7%) in the mononuclear cell group. RESULTS: A comparative study between these 2 groups was carried out. There were no significant differences in ulcer healing in the first 6 months, but 6 months and one-year post-treatment, they were found. At 6 months, no patient in the conventional surgery group showed dehiscence or fistulization of the wound and, one year after surgery, only 3.17% recurred in the conventional group. In addition, there was a statistically significant relationship between days of hospitalization and the type of bacterial contamination and the intervention group. CONCLUSION: Bone marrow mononuclear cell infusion-infiltration is an alternative treatment for PIs and fistula during the first 6 months, instead of conventional surgery. However, in the medium-long term, conventional surgery is more effective.

Keratocyst Capnocytophaga superinfection.

INTRODUCTION: Capnocytophaga spp are Gram-negative bacteria that cause severe infections in immunosuppressed patients. This situation is extremely rare in immunocompetent patients. CASE REPORT: This clinical report describes the unusual infection of an immunocompetent patient with Capnocytophaga spp. The imaging studies showed the existence of a cyst in the left jawbone. After treatment and a microbiological study of the content, it was found to be an outbreak of septicaemia. DISCUSSION: Capnocytophaga spp, commensal bacteria of the oral cavity, can lead to serious illness and that is why an empirical treatment is needed until a diagnostic confirmation can be obtained.

Regeneration of mandibular defects using adipose tissue mesenchymal stromal cells in combination with human serum-derived scaffolds.

Bone regeneration is a challenging issue. Traditional solutions bring risks, potential complications, and morbidity. The aim of the present study was to regenerate critical-sized mandible defects in athymic rats with adipose tissue mesenchymal stromal cells (AT-MSCs) in combination with human serum-derived scaffolds. Two approaches to treatment were performed. The first approach used differentiated stromal cells that became osteogenic cell lines. The second approach used no pre-differentiation. Follow-up periods were 45 days and 90 days. Both cell types were combined with human serum-derived scaffolds. Afterward, histological (haematoxylin-eosin and Masson's Trichrome stain modified by Goldner), immunohistochemical (human vimentin and Stro-1), and radiological (microCT) studies were performed. The level of calcification between the groups was compared by analysis of variance, and statistical significance was set at p < 0.05. The results demonstrate that bone regeneration can be achieved with both undifferentiated and pre-differentiated cells, but that the structure and level of calcification were better achieved with pre-differentiated cells (p < 0.05). The scaffold is suitable for this cell type, is osteoconductive and simple to perform. This article highlights the possible application of adipose tissue mesenchymal stromal cells in combination with a non-mineralized scaffold in bone regeneration.

Asistolia por compresión del seno carotídeo: una complicación potencialmente fatal de la parotiditis vírica / Asytolia due to compression of the carotid sinus: a potentially fatal complication of viral parotiditis

La parotiditis es una enfermedad vírica aguda, caracterizada por fiebre e hinchazón dolorosa de una o más glándulas salivales, generalmente la parótida, aunque pueden afectarse las glándulas submaxilares y sublinguales. El cuadro clínico inicial es inespecífico, aunque en las primeras 24 h suelen aparecer otalgia y sensibilidad dolorosa en la parótida. Además, pueden aparecer complicaciones a nivel extraglandular, sobre todo a nivel neurológico, testicular, pancreático, articular y cardíaco. Entre estas últimas, las más frecuentes son los cambios electrocardiográficos. También está ampliamente descrita la miocarditis vírica. Presentamos una rara complicación, no descrita en la literatura, de asistolias recurrentes provocadas por la compresión del seno carotídeo, debido a la inflamación local producida por la parotiditis (AU)

Mumps is an acute viral disease, characterized by fever and painful swelling of one or more salivary glands, usually the parotid, and sometimes the sublingual or submandibular glands. The initial clinical picture is non-specific, but during the first 24 h there is otalgia and tenderness in the parotid gland. Apart from the involvement of the salivary glands, neurological, testicular, pancreatic, joint, or cardiac complications may occur. Among the latter, the most frequent are the electrocardiographic changes. Viral myocarditis has also been widely reported. We report a rare complication, not yet described in the literature, of recurrent asytolia produced by compression of the carotid sinus as a result of local inflammation caused by mumps (AU)

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Sebaceous adenoma of the parotid gland.

Tumors of the salivary glands constitute an important field of oral and maxillofacial pathology. The majority of salivary gland neoplasms are benign, with malignant salivary tumors accounting for 15 to 32 percent. The most common site for salivary gland tumors is the parotid gland, accounting up to 80 percent of all cases. This article reports the pathologic picture in a case of sebaceous adenoma of the parotid gland. The tumor was composed of epithelial cells lining ducts and closely associated with broad areas of sebaceous differentiation. The growth pattern was predominantly cystic, with cavities filled with sebaceous material. Areas of oncocytic metaplasia were also seen. The presence of sebaceous glands in salivary neoplasms is frequent, however, and in spite of this, salivary neoplasms constituted partially or entirely of these cells are rarely observed. To the surgeon and pathologist, the major problem in dealing with sebaceous adenoma is the recognition of this rare entity, avoiding confusing with other more aggressive neoplasms. The treatment involves surgical excision. The addition of the current case to the previously published data brings the total number of parotid sebaceous adenoma to seven.

Adenoma sebáceo de la glándula parótida / Sebaceous adenoma of the parotid gland

Los tumores de las glándulas salivales constituyen un área importante de la patología oral y maxilofacial. La mayor parte de las neoplasias glandulares salivales son benignas, representando las malignas entre el 15 y el 32% del total. La localización más común de estas entidades es la glándula parótida, en la que asientan hasta el 80% de todos los casos. En este artículo se presenta un caso de adenoma sebáceo salival, de localización parotídea. El tumor, formado por células epiteliales que tapizan conductos, exhibe amplias áreas de diferenciación sebácea y zonas con metaplasia oncocítica. El patrón histológico es predominantemente quístico, observándose cavidades rellenas con material sebáceo. Si bien la presencia de glándulas sebáceas en las glándulas salivales es frecuente, las neoplasias exclusivamente formadas por las mismas son muy infrecuentes. Dada su rareza, este tumor plantea problemas diagnósticos diferenciales con otras entidades benignas y malignas. Su tratamiento implica la extirpación de la lesión, lo que generalmente involucra la eliminación de la glándula en la que ha surgido. El presente caso constituye el séptimo publicado de esta entidad

Tumors of the salivary glands constitute an important field of oral and maxillofacial pathology. The majority of salivary gland neoplasms are benign, with malignant salivary tumors accounting for 15 to 32 percent. The most common site for salivary gland tumors is the parotid gland, accounting up to 80 percent of all cases. This article reports the pathologic picture in a case of sebaceous adenoma of the parotid gland. The tumor was composed of epithelial cells lining ducts and closely associated with broad areas of sebaceous differentiation. The growth pattern was predominantly cystic, with cavities filled with sebaceous material. Areas of oncocytic metaplasia were also seen. The presence of sebaceous glands in salivary neoplasms is frequent, however, and in spite of this, salivary neoplasms constituted partially or entirely of these cells are rarely observed. To the surgeon and pathologist, the major problem in dealing with sebaceous adenoma is the recognition of this rare entity, avoiding confusing with other more aggressive neoplasms. The treatment involves surgical excision. The addition of the current case to the previously published data brings the total number of parotid sebaceous adenoma to seven

Consensus statement on antimicrobial treatment of odontogenic bacterial infections.

The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc) confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg/125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection.

Maxillofacial cellulitis.

Of all infections associated to oral pathology, the most relevant ones are those that are related to dental pathology. Cellulitis is an infection of the cellular adipose tissue located in the aponeurotic spaces. It can be classified on the basis of location, severity and evolution. The aponeurotic compartments that allow odontogenic infections to spread have been categorised as: superficial compartment, floor of the mouth, masticator compartment, parapharyngeal space, parotid space and paratonsillar space. The present work describes the anatomical structures that comprise these spaces. The clinical forms of facial cellulitis are divided into acute and chronic. Potential complications consist of orbital infections, necrotising fascitis, thrombosis of the cavernous sinus, cerebral abscess and mediastinitis. Diagnosis is made on the basis of anamnesis, physical examination and complementary procedures (analytical tests and imaging studies). Treatment includes: treatment of causes (depending on the underlying cause in each case), incision and drainage, antibiotic therapy (chosen empirically) and complementary medical care. Odontogenic infections are primarily treated with surgery and coadjuvant antibiotic therapy.

Documento de consenso sobre el tratamiento antimicrobiano de las infecciones bacterianas odontogénicas / Consensus statement on antimicrobial treatment of odontogenic bacterial infections

Las infecciones de la cavidad bucal son un problema de salud pública frecuente y motivo constante de prescripción antibiótica; el 10% de los antibióticos se emplean para tratar este problema. Sin embargo, hasta la fecha son pocos los estudios realizados para determinar su incidencia. Asímismo, su relación con ciertas enfermedades sistémicas (cardiacas, endocrinas, etc...) confiere a estas patologías una importancia vital. A pesar de la reconocida frecuencia e importancia de las infecciones odontogénicas, llama la atención la actual dispersión de criterio en varios aspectos referentes a su clasificación, terminología y recomendaciones terapéuticas. El objetivo principal de este documento, realizado con el consenso de especialistas en microbiología y odontología, es establecer unas recomendaciones útiles para todos los profesionales implicados en el manejo clínico de estas patologías. Recibe especial atención el aumento de la prevalencia de resistencias bacterianas observado durante los últimos años y, en concreto, la proliferación de cepas productoras de betalactamasas. Otro factor causal importante de la aparición de resistencias es la falta de cumplimiento terapéutico, en especial en lo que respecta a la dosis y a la duración del tratamiento. Así pues, estas patologías constituyen un problema complejo cuyo abordaje requiere la instauración de antimicrobianos de amplio espectro, con adecuados parámetros farmacocinéticos, con buena tolerancia y una posología cómoda que permita que el paciente reciba la dosis adecuada durante el tiempo necesario. Amoxicilina/ácido clavulánico a dosis altas (2000mg/ 125mg) ha demostrado buenos resultados y capacidad para superar resistencias. Otros agentes como metronidazol y clindamicina, seguidos de claritromicina y azitromicina han demostrado también ser activos frente a la mayoría de los microorganismos responsables de las infecciones odontogénicas (AU)

The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc…) confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg / 125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection (AU)

Celulitis maxilofaciales / Maxillofacial cellulitis

De todas las infecciones vinculadas con la patología oral, las principales son las relacionadas con la patología dentaria. Las celulitis son infecciones del tejido celuloadiposo situado en los intersticios aponeuróticos. Pueden ser clasificadas según criterios de localización, gravedad y curso evolutivo. Los compartimentos aponeuróticos que permiten la diseminación de una infección odontogénica han sido clasificados en: compartimento superficial, suelo de la boca, compartimento masticador, espacio parafaríngeo, espacio parotídeo y espacio paratonsilar. En este estudio se describen las estructuras anató- micas que los conforman. Las formas clínicas de las celulitis faciales se dividen en agudas y crónicas. Las complicaciones que pueden presentarse son infecciones orbitarias, fascitis necrotizante, trombosis del seno cavernoso, absceso cerebral y mediastinitis. El diagnóstico se realizará mediante anamnesis, examen físico y estudios complementarios (analíticos y de imagen). El tratamiento incluirá: tratamiento causal (en función de la causa que lo genere), incisión y drenaje, antibioterapia (de elección empírica) y cuidados médicos complementarios. Las infecciones odontogénicas son de tratamiento primariamente quirúrgico, jugando la antibioterapia un papel coadyuvante (AU)

Of all infections associated to oral pathology, the most relevant ones are those that are related to dental pathology. Cellulitis is an infection of the cellular adipose tissue located in the aponeurotic spaces. It can be classified on the basis of location, severity and evolution. The aponeurotic compartments that allow odontogenic infections to spread have been categorised as: superficial compartment, floor of the mouth, masticator compartment, parapharyngeal space, parotid space and paratonsillar space. The present work describes the anatomical structures that comprise these spaces. The clinical forms of facial cellulitis are divided into acute and chronic. Potential complications consist of orbital infections, necrotising fascitis, thrombosis of the cavernous sinus, cerebral abscess and mediastinitis. Diagnosis is made on the basis of anamnesis, physical examination and complementary procedures (analytical tests and imaging studies). Treatment includes: treatment of causes (depending on the underlying cause in each case), incision and drainage, antibiotic therapy (chosen empirically) and complementary medical care. Odontogenic infections are primarily treated with surgery and coadjuvant antibiotic therapy (AU)

Small cell undifferentiated carcinoma of the submandibular gland with neuroendocrine features.

This article reports the clinical, histopathologic, and immunohistochemical findings in a case of small cell undifferentiated carcinoma of the submandibular gland. The tumor was composed of anaplastic cells slightly larger than lymphocytes without ductal differentiation. On immunohistochemical analysis, the tumor contained cells that reacted positively with antibodies to cytokeratin, neuron-specific enolase, synaptophysin, and chromogranin. The present case supports the hypothesis that small cell undifferentiated carcinomas of the salivary glands arise from presumed multipotential ductal stem cells. When this tumor entity is located on the salivary glands, it appears to behave less aggressively than when it is a primary tumor of the bronchial tree.

Infección por el virus de la hepatitis C y riesgo de transmisión en cirugía oral / Hepatitis C virus infection and risk of transmission in oral surgery

La hepatitis viral es la principal causa de enfermedad hepatica. Aproximadamente el 85 por ciento de los individuos infectados por el virus de la hepatitis C (VHC) progresa a una infección crónica y, de estos, entre el 1 y el 4 por ciento cada año desarrolla un carcinoma hepatocelular. Además de la lesión hepática, el virus C puede afectar a tejidos y órganos extrahepáticos dando lugar a diferentes manifestaciones, como el líquen plano oral, sialadenitis y quizá cáncer oral.El objetivo de este trabajo es revisar el riesgo ocupacional de la infección por VHC entre dentistas y cirujanos orales. Ambos deben saber como incorporar el diagnóstico de infección por VHC en el plan de tratamiento quirúrgico programado. También se revisarán la historia natural y la transmisión de este virus vehiculizado por la sangre. (AU)

Neck schwannomas.

Schwannomas are peripheral nerve tumours of nerve sheath origin. Twenty-five to 45 percent of extracranial schwannomas occur in the head and neck region. We present 2 cases of schwannomas that arise from the vagus and cervical plexus. These lesions are uncommon and most often present as asymptomatic solitary neck mass. Preoperative diagnosis can be difficult and conservative surgical excision remains the treatment of choice, often requiring sacrifice of a portion of the nerve.

Schwannomas cervicales / Neck Schwannomas

Los schwannomas son tumores de los nervios periféricos originados a partir de las vainas neurales. Entre el 25 per cent y el 45 per cent de los schwannomas originados en el nervio vago y en el plexo cervical. Estas lesiones son infrecuentes y suelen presentarse como masas cervicales solitarias asintomáticas. El diagnóstico preoperatorio puede ser difícil y la exéresis quirúrgica conservadora constituye el tratamiento de elección, si bien a menudo requiere el sacrificio de una porción del nervio de origen (AU)

Diagnóstico y plan de tratamiento en cirugía ortognática / Diagnosis and Treatment Planning in Orthognatic Surgery

La cirugía ortognática es una práctica cada vez más extendida y que, en el momento actual, no se aplica exclusivamente en deformidades dentofaciales extremadamente severas. Debido a sus implicaciones tanto estéticas como funcionales, los pacientes aceptan cada vez con más frecuencia someterse a este tipo de tratamientos. El objetivo de este trabajo consiste en mostrar al odontólogo general algunos de los aspectos concernientes al manejo que realiza el cirujano con respecto al diagnóstico y plan de tratamiento de este tipo de deformidades. (AU)

Carcinoma escamoso oral en pacientes trasplantados. Estado actual de la cuestión / Oral squamous carcinoma in solid organ transplant recipients. New perspectives

Los cánceres de cabeza y cuello representan el 15 por ciento de todos los tumores malignos en los pacientes trasplantados. La principal causa que justifica este incremento de incidencia con relación a la población general, es el significativo aumento de los cánceres de labio. En el presente trabajo se documentan dos casos de carcinoma epidermoide oral desarrollados en pacientes sometidos a un trasplante renal. Se realiza una revisión sobre la cuestión, definiendo aquellos aspectos de mayor trascendencia clínica para el odonto-estomatólogo. (AU)

Regeneración tisular en defectos óseos adyacentes a implantes dentales. Estudio morfológico y estructural / Tissue regeneration in bone defects adjacent to dental implants. A morphologic and ultratructural study

Objetivo: este estudio fue realizado para comparar el grado de reparación tisular observado en defectos óseos adyacentes a implantes endostales colocados en tibias de cerdos Material y método: se colocaron 24 implantes en las tibias de tres cerdos, disponiéndose también 24 defectos óseos cilíndricos adyacentes a los 5 mm coronales de cada fijación. De estos defectos, 18 fueron rellenados con hueso liofilizado desmineraliado, hidroxiapatita, o cubiertos con membranas de politetrafluoroetileno expandido. Los animales fueron sacrificados al cabo de 1, 2 y 3 meses. El tejido óseo neoformado fue evaluado mediante análisis morfológico y ultraestructural. Conclusión: los resultados indican que al cabo de 1, 2 y 3 meses de postoperatorio, la densidad ósea fue mayor en defectos óseos tratados con membranas de politetrafluoroetileno expandido (AU)

Rehabilitación quirúrgico-prostodóntica implantosoportada en fisurado palatino: a propósito de un caso clínico / Implant-supported surgical-prosthetic rehabilitation in a cleft palate patient. A propos of a clinical case

Se presenta el caso clínico de una mujer de 43 años con secuelas de una fisura palatina unilateral, a la que se realizó tratamiento quirúrgico previo a la inserción de una prótesis implantosoportada. El tratamiento quirúrgico consistió en la elevación del suelo del seno maxilar, en la preservación con hidroxiapatita porosa del alveolo de un incisivo central extraído por periodontitis aguda y en la instalación de cuatro implantes osteointegrados, en ambos segmentos de la fisura (AU)

Rehabilitación quirúrgico-prostodóntica implantosoportada en fisurado palatino: a propósito de un caso clínico / Implant-supported surgical-prosthetic rehabilitation in a cleft palate patient. A propos of a clinical case

Se presenta el caso clínico de una mujer de 43 años con secuelas de una fisura palatina unilateral, a la que se realizó tratamiento quirúrgico previo a la inserción de una prótesis implantosoportada. El tratamiento quirúrgico consistió en la elevación del suelo del seno maxilar, en la preservación con hidroxiapatita porosa del alveolo de un incisivo central extraído por periodontitis aguda y en la instalación de cuatro implantes osteointegrados, en ambos segmentos de la fisura